Wiki 19120 or 21555

rkindlund

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Based on this op report (it is a male) I am inclined to go with 21555 but can also see 19120. Path report came back as a lipoma. What would you code?

Name of Procedure:

Excisional breast mass.



Preoperative Diagnosis:

Left breast mass and right breast mass.


Description of Procedure:

Patient brought to the operating room, prepped and draped in standard sterile fashion. He was given 2 g of IV Ancef on induction of anesthesia. I began on the left breast mass. I made a skin incision after injection 0.25% Marcaine with epinephrine. I went down onto the soft tissue mass. This was easily delivered off the field and will be sent for permanent in formalin. This looked very much like a lipoma and the patient has a history of multiple lipomas. I then turned my attention to the right breast mass. In like manner, I injected local anesthetic, used a 15-blade scalpel to open the skin, dissected down. The soft tissue mass was easily delivered. I used electrocautery for hemostasis and the wounds were closed with

3-0 Vicryl in the dermis and 4-0 Monocryl in subcuticular fashion. Patient tolerated procedure well.
 
Excision of a lipoma of the trunk would be 11400-11406 and dx 214.6, since the size was not documented the lowest code would be used.

The depth is no further than below the dermal layer.

21555 is of the neck and thorax, that is higher than the breast.

19120 is much more extensive with nipple involvement.
 
OCD_coder: I'm curious as to why you are using 11400-11406 as this lipoma removal code, when 11400-11406 are SKIN lesion removal codes. A lipoma is by definition a "tumor of the soft tissue," necessitating the 20000 series code for a biopsy-proven lipoma. I believe the 21555 is the correct code in this instance (x2).
 
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